NPIMap

Organization Active NPI

Concierge Medical Lab

  • Primary Care Clinic/Center
  • Columbia, SC
National Provider Identifier
1366220758
Registry record updated May 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
CONCIERGE MEDICAL LAB
Doing business as
Concierge Medical Lab
Practice address
110 Wildewood Park Dr Ste a
Columbia, SC 29223-4301
Phone
(803) 722-9888
Fax
(803) 656-8135
NPI assigned
Sep 18, 2023
Last updated
May 28, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
CONCIERGE MEDICAL GROUP LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 28, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sarah Doctor-GreenwadeNPI 1801392634
Title
Chief Executive Officer
Phone
(803) 722-4988

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical & Laboratory Immunology (Internal Medicine) Physician 207RI0001X
Medical Laboratory Technician 246RM2200X
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

110 Wildewood Park Dr Ste a
Columbia, SC 29223-4301

Mailing address

PO Box 23328
Columbia, SC 29224-3328
Phone (803) 722-4988

Other names 1

  • Concierge Medical Lab Doing business as

National Provider Directory

National Provider Directory
Part of
Concierge Medical Lab

Locations

110 Wildewood Park Dr
Ste A
Columbia, SC 29223
Phone (803) 722-4988

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1694995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716854400000",
    "number": "1366220758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23328",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292243328",
            "telephone_number": "803-722-4988",
            "fax_number": "803-656-8135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 WILDEWOOD PARK DR STE A",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292234301",
            "telephone_number": "803-722-9888",
            "fax_number": "803-656-8135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONCIERGE MEDICAL LAB",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CONCIERGE MEDICAL GROUP LLC",
        "enumeration_date": "2023-09-18",
        "last_updated": "2024-05-28",
        "certification_date": "2024-05-28",
        "status": "A",
        "authorized_official_last_name": "DOCTOR-GREENWADE",
        "authorized_official_first_name": "SARAH",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "803-722-4988"
    },
    "taxonomies": [
        {
            "code": "207RI0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical & Laboratory Immunology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "246RM2200X",
            "taxonomy_group": "",
            "desc": "Technician, Pathology, Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Concierge Medical Lab",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Concierge Medical Lab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Columbia, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.